United States Genersl Accounting OflIce

GM Human Resources Division

April 1992

F4GiZzTJ~ Health Reports

GAO/HRD-92-84

Preface

Health Reports is a list of reports and testimonies issued by the General Accounting Office (GAO) over the past 2 years. Organized chronologically, the entries provide a title, report number, and issue date for each GAO

health product. Reports and testimonies on the same topic may be combined into a single entry.

The first section-Recent GAO Products-summarizes reports and testimonies on selected health issues published from November 1991 through February 1992. The summaries are followed by a list of additional products published during the same period. The remainder of Health Reports is a list of health products published from February 1990 through February 1992 organized by subject areas as shown in the table of contents. As appropriate, entries have been cross-indexed and are included in more than one subject area. An order form to request GAO products is included at the back of this report.

Page1

Contents

Preface 1

A Recent GAO Products 4

Summaries of Seleckd Reports 4 List of Additional GAO Health Products 9

1

Health F’inancing and 11

Access

Medicare and 13

Medicaid

Public Health and 17

Education

Health Quality and 18 Practice Standards

Long-Term Care and 20

Aging

Substance Abuse and Drug ‘Ikeatment

Military and Veterans Health Care

21

23

Employee and Retiree Health Benefits

26

Other Health Issues Food and Drug Administration Medical Malpractice Prescription Drugs Miscellaneous

27 27 27 28 28

Page 2

contenta

Order Form

Abbreviations

ADMS Alcohol, Drug Abuse and Mental Health Services ADP automatic data processing AIDS acquired immunodeficiency syndrome CHAMPUS Civilian Health and Medical Program of the Uniformed

Services DOD FDA

GAO HCFA HHA HHS Hhfa MSP NAIC OSHA PRO VA

Department of Defense Food and Drug Administration General Accounting Office Health Care Financing Administration home he&h agency Department of Health and Human Services health maintenance organization Medicare secondary payer National Association of Insurance Commissioners Occupational Safety and Health Administration peer review organization Department of Veterans Affairs

Page 8

Recent GAO Products (Now 1991-Feb. 1992)

Summaries of Selected Reports

Differences (Feb. 13,1992, GAOIHRBQZ-S~).

- In most states, per capita spending on personal health care is near the US. average of $2,255 per capita in 1990. Many states with higher spending levels are concentrated in the Northeast, Midwest, and Far West, while many states with lower per capita spending are in the South and Rocky Mountain regions. Differences among states result largely from factors that state governments can do little to control. Most state differences in per capita personal health spending result from variations in personal income, health care services’ capacity (including the number of physicians and hospital and nursing home beds), the concentration of hospital services in urban areas, and health status.

Medigap Insurance: Insurers Whose Loss Ratios Did Not Meet Federal Minimum Standards in 1988-89 (Feb. 28,1992, G~oi~~~o2-u).

The overall percentages of premiums that insurance companies returned to Medigap policyholders as benefits (called the loss ratio) declined from 1988 to 1989. Federal minimum standards on loss ratios were the same in 1988 and 1989: 75 percent for policies sold to groups and 60 percent for policies sold to imlividuaJs. Medigap insurers’ 1988 loss ratios were 85*6 percent on individual policies and 95.7 percent on group policies. In 1989, the aggregate loss ratios for both types of policies were about 82 percent.

Medicare: Over $1 Billion Should Be Recovered From Primary Health hksurers(Feb.21, 1992, G~Ol~~r~92-62).

Medicare contractors have signifkant backlogs of mistaken payments for Medicare beneficiaries that are unrecovered from primary health insurers. Medicare contractors recently surveyed by HCFA reported backlogs of over $1 billion in Medicare payments that were mistakenly paid. These backlogs could increase as a result of (1) a recently initiated HCFA effort to identify additional primary insurers and (2) contractors’ research of previously paid beneficiary claims. Millions of dollars may be lost due to an HHS regulation that limits the time a contractor has to initiate recovery on a claim after it identifies a primary insurer. Collections of Medicare secondary payer (MSP) program mistaken payments far exceed carriers’ cost of recovery. Medicare contractors advised HCFA that inadequate MSP funding is the reason for backlogs of mistaken payments.

Page4 GMMHRD-9%84HedthEeporls

Reeent GAO Pmdncta (Nov. 1BOl-Feb.1098)

drug Education: Rural Programs Have Many Components and Most Rely Heavily on Federal Funds (Jan. 31,1Q92, GAOEIRDQZ-M).

Student drug use is a problem in rural areas. Most school districts are implementing multifaceted programs to combat the student drug problem. Drug-Free Schools grants are the primary source of drug education and prevention funding in over half of all rural school districts.

Medicare: Rationale for Higher Payment for Hospital-Based Home Health Agencies (Jan. 31,1992, GAMRDQZZP).

Allowing hospitals additional reimbursement for home health services is consistent with Medicare payment principles and federal legislation. This added amount is designed to pay a hospital for legitimate costs allocated to its home health agency (HHA) if those costs cause its total HHA costs to exceed predetermined Medicare cost limits. The effect of this policy is to pay some hospitals more than freestanding HHAS for the same services. In some instances these added payments may not be necessary to assure beneficiary access to home health care.

VA Health Care for Women: Despite Progress, Improvements Needed (Jan. 23, 1992, GAO/HRD92-23).

VA has made significant progress since 1982 toward ensuring that female veterans have equ& access to health care as male veterans. However, some problems remain in caring for women veterans. Physical examinations, including cancer screening, continue to be sporadic. VA medical centers are inadequately monitoring in-house -ogr@w programs to ensure compliance with American College of Radiology quality standards.

Adolescent Drug Use Prevention: Common Features of Promising Community Programs (Jan. 16,1992, GAOIPEMD-92-2).

Definitive evidence is not yet available to demonstrate the effectiveness of the comprehensive, community-based drug abuse prevention programs GAO surveyed or visited; nevertheless, some programs appear to be making much more headway than others. GAO found similarities in the ways that the most promising programs delivered services, even though the services themselves were often quite different.

Page6

Recent GAO Products (Nov. 1991-Feb. 1992)

Budget Issues: 1991 Budget Estimates: What Went Wrong (Jan. 15,1992, GAOAXX-92-l).

One chapter of this report addresses issues affecting accurate forecasts of federal Medicaid expenditures. Specifically, the fiscal year 1991 estimates of federal Medicaid outlays made in January 1990 were $7.5 billion lower than the actual outlays reported in October 1991, a 14-percent estimation error. Medicaid cost estimates increased because of federal and state legislation, court decisions, and other program changes affecting eligibility and reimbursement rates. Federal expenditures grew because of increased use of states’ provider donations and provider-specific taxes. Changes in economic conditions also affected Medicaid spending.

Hispanic Access to Health Care: Significant Gaps Exist (Jan. 15,1992, GAOLPEMD-926). Testimonyonsame WpiC(Sept. 19,1991, GAO/I'-PEMD91-13).

Hispanics are much less likely than others to have health insurance coverage. In 1989,33 percent of all Hispanics were without health insurance. Lack of insurance was especially acute for the Mexican-American community, where 37 percent were uninsured. Employment and income are key determinants of the high rates of noninsurance among Hispanics. In some states, Hispanics, paiticlllarly Mexican-Americans, have difficulty in gaining access to Medicaid because of stringent state eligibility criteria.

Drug Abuse Research: Federal Funding and Future Needs (Jan. 14,1992, GAOfiEMD92-6). Testimonyonsame tOpiC(&pt.25, 1991, GAO/PEMD-T-91-14).

The National Institute on Drug Abuse in the Department of Health and Human Services and Office of Justice Programs in the Department of Justice are the two principal agencies receiving federal support for drug abuse research. Funding for drug abuse research increased by over 200 percent between 1980 and 1990 and by over 400 percent if funding for AIDS is included. Experts that GAO spoke with identified the importance of further research on the psychological and social/environmental factors that lead to drug abuse.

Medical Malpractice: Alternatives to Litigation (Jan. 10,1992, GAO/IiRB9%28).

Arbitration and no-fault programs are alternatives to litigation. Fifteen states have specific statutes on medical malpractice arbitration. Vii

Page 9 GAOmBD-92-84 Health Reporta

Eaeent GAO Probeta (Nov. 1091-Feb. 1BW

and Florida enacted statutes authorizing no-fault programs to resolve certain birth-related injury claims. Michigan is the only state that (1) has a method to make patients aware of the arbitration option and (2) established a program to implement its statute’s requirements. But even in Michigan, relatively few malpractice claims have been filed for arbitration compared with those filed for litigation. At least two private sector I-IM(XS, covering over 6 million enrollees, have mandated the use of arbitration to resolve malpractice claims. Also, a demonstration project in Maine has established standards of care in four specialties. Starting in 1992, those participating physicians who follow the standards may be protected fkom litigation. However, Maine officials expect the legality of the approach to be challenged.

Long-Term Care Insurance: Risks to Consumers Should Be Reduced (Dec. 26,1991, GAO/HRD-92-14). Testimony on same topic (Apr. 11,1991, GACWHRD-91-14).

The National Association of Insurance Comnussioners (NAIC) model standards for long-term care insurance provide greater consumer protection than existed before 1986. However, consumers are still vulnerable to considerable risks. GAO discusses additional standards that are necessary to improve consumer protection. Moreover, if states do not adopt NAIC standards, the Congress may wish to consider enacting legislation that sets minimum federal standards for long-term care insurance.

Breast Cancer, 197181: Prevention, Treatment, and Research (Dec. 11, 1991, GAWEMDQ%12). Testimony on same topic (hc. 11, 1991, GA(M‘-PEMDQ2-4).

The last 20 years can be summariz ed both as a period of major advances against breast cancer and as one when the most important indicators of progress have seen no improvement. GAO assessed the potential for future advances in the prevention of breast cancer,

Medical Residents: Options Exist to Make Student Loan Payments Manageable (Nov. 26, 1991, GAO/HRDQ~-~I).

Beginning in January 1990, the Congress limited medical residency deferments for repayment of Stafford loans to 2 years. This limitation may cause financial hardship for medical residents. However, medical residents can make their student loan debt more manageable by exercising debt

Page 7 e-92.84HerltbReporta

Recent GAO Produeta (Nov.l991-Feb.1992)

relief options, such as the forbearance of principal and interest for Stafford loan payments. The Congress may want to consider amendments that would require lenders to grant residents’ requests for such debt relief.

Health Care Spending Control: The Experience of France, Germany, and Japan (Nov. 15,1991, GAOIHRD-~~-O). TeSimony on same topic (Nov. 19, 1991, GAWMRIT92-12).

France, Germany, and Japan achieve near-un.ivemaI health insurance coverage. This report describes these countries’ health insurance and financing methods, their policies intended to restrain health care spending increases, and the effectiveness of these policies. While GAO does not endorse the specifk health systems of these countries, their strengths and weaknesses could be instructive in helping resolve U.S. health care problems.

Medicare: HCFA Needs to Take Stronger Actions Against HMOS Violating Federal Standards (Nov. 12,1991, GAOI'HRD-9%~). Testimony on same topic (Nov.15,1991, GAO/T-HFtD9Zll).

During the past decade, the Health Care Financing Administration (HCFA) has encouraged Medicare beneficiaries to enroll in health maintenance organizations (~~09). Yet HCFA has not been able to get certain HMOS to promptly correct Medicare violations. Widespread problems with Humana Medical Plan in Florida, Medicare’s largest HMO contractor, demonstrate HCFA'S unwillingness and inability to enforce Medicare’s minimum beneficiary safeguard standards.

Defense Health Care: C~AMPUS Mental Health Benefits Greater Than Those Under Other Health Plans (Nov. 7,1991, GAOIHRD-~~-~O).

DOD's Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) pays for a substantial portion of the he&h care that civilian hospitals, physicians, and other providers give to DOD beneficiaries. This report compares available CHAMPUS benefits for mental and substance abuse treatment with similar benefits under private sector plans and under the Federal Employees Health Benefits Program. CHAMPUS benefits and cost-sharing requirements for mental health and substance abuse are more generous than those offered to private sector and federal employees.

Page8

Recent GAO Productn (Nov. 1991-Feb. lB9P)

r

List of Additional GAO Center (Feb. 26,1992, GAOIHRISOM~). Health Products ~

FDA Regulations: Sustained Management Attention Needed to Improve Timely Issuance (Feb. 21,1992, GAOIHRDO~~S).

Hired Farmworkers: He&h and Well-Being at Risk (Feb. 14,1992, GAO/HRD9246).

Federal Health Benefits Program: Stronger Controls Needed to Reduce Administrative Costs (Feb. 12,1992, GAO/GGLH@.

Operation Desert Storm: Fuli Army Medical Capability Not Achieved (Feb.5, 1992, GAO/T-NSLm-92-S).

Medicare: Third Status Renort on Medicare Insured G~OUD Demonstration Projects(Jan.29,1992, GAOmRD-92-63).

VA Health Care: Modernizing VA'S Ma&Service Pharmacies Should Save Millions of Dollars (Jan. 22,1992, GAOMRD-02-30).

International Environment: Kuwaiti Oil Fires-Chronic Health Risks Unknown but Assessments Are Under Way (Jan. 16,1992, GAO/RCED-0243OBR).

Defense Heaith Care: Transfers of Military Personnel With Disabled Children (Jan. 9,1992, GAOMRIHXU).

Defense Health Care: Efforts to Address Health Effects of the Kuwait Oil WehFireS(Jan.9,1992, GAO/HRD-02-60).

Veterans’ Benefits: Savings from Reducing VA Pensions to Medicaid- Supported Nursing Home Residents (Dec. 27,1991, cxomm-oxa).

Aging Issues: Related GAO Renorts and Activities in F’iscal Year 1991 (Dec. 17, 1991, GAomR&92-67).

VA Health Care: Compliance With Joint Commission Accreditation Requirements Is Improving (Dec. 13,1991, GAOMRD-92-10).

Page 9

Y

Recent GAO Pro&&m (Nov. 1991~Fub. 1999)

DOD Medical Inventory: Reductions Can Be Made Through the Use of Commercial Practices (Dec. 6,1991, GACVNSWMS). Testimony on same topic @t?C. 5, 1991, GAOR-NSIADOM).

Occupational Safety 81 Health: OSHA Action Needed to Improve Compliance With Hazard Communication Standard (Nov. 26,1991, GAOJ-IRDOZB).

Medicare: Effect of Durable Medical Equipment Fee Schedules on Six Suppliers’ Profits (Nov. 6,1991, GACVHRDM-2~).

Signikant Reductions in Corporate Retiree Health Liabilities Projected If Medicare Eligibility Age Lowered to 60 (Nov. 6,1991, GAOR-HRD~%~).

P4gelO GAoIEIBD-92-94 Health Eeporte

Health Financing md Access

Health Care Spending: Nonpolicy Factors Account for Most State Differences (Feb. 13,1992, GAO/HRD-0~36).

Federal Health Benefits Program: Stronger Controls Needed to Reduce Administrative Costs (Feb. 12, 1992, GAOIGGD-92-27).

Budget Issues: 1991 Budget Estimates: What Went Wrong (Jan. 15,1992, GACYOCG-92-I).

Hispanic Access to Health Care: Significant Gaps Exist (Jan. 16,192, GAOPEMD-9~). Testimony on same topic (Sept. 19,1991, GAOII-~~~~91-13).

Health Care Spending Control: The Experience of France, Germany, and Japan (Nov. 15, 1991, GAO/HRDO~-9). Testimony on same topic (Nov. 19, 1991, GAO/T-HRD-92-12).

Off-Label Drugs: Reimbursement Policies Constrain Physicians in Their Choice of Cancer Therapies (Sept. 27, 1991, GAOIPEMD-91-14).

States Need More Department of Labor Help to Regulate Multiple Employer Welfare Arrangements and Correct Problems (Sept. 17,1991, GAO/T-HRD-91-U).

Managed Care: Oregon Program Appears Successful but Expansion Should Be Implemented Cautiously (Sept. 16,1991, GAOR‘-HRD-0~6).

Rural Hospitals: Closures and Issues of Access (Sept. 4,1991, GAO/F-HRD-9146).

Nonprofit Hospitals: Better Standards Needed for Tax Exemption (July 10, 1991,GA~-HRD-Q1-43).~pOrtOn~e~piC(May~, 1990, GAOiHRD-oQ-84).

Private Health Insurance: Problems Caused by a Segmented Market (July 2,1991, GAO~HRD-01-114). Testimony on same topic (May 2, 1991, GAO,'T-HRDSl-21).

U.S. Health Care Spending: Trends, Contributing Factors, and Proposals for Reform(June 10,19!91, GAO/HRDDI-102). Testimony onsametopic (Apr. 17, 1991, GAO/T-HRITBl-16).

Page 11

Canadian Health Insurance: tins for the United States (June 4,1991, GA~RD-OMO). Testimony on same topic (June 4,1991, GAOIT-HRBO~~S).

Trauma Care: Lifesaving System Threatened by Unreimbursed Costs and other Factors (May 17,1991, GAOlHRD-gl67).

Retiree Health: Company-Sponsored Plans Facing Increased Costs and Liabilities (May 6,1991, GAO/T-HRBOM).

Workers at Risk: Increased Numbers in Contingent Employment Lack Insurance, Other Benefits (Mar. 8,1991, GAOIHRD-01-66).

Medigap Insurance: Better Consumer Protection Should Result From 1990 Changes to Baucus Amendment (Mar. 5,1991, GAOIHRDO~~O).

Rural Hospitals: Federal Efforts Should Target Areas Where CIosure-s Would Threaten Access to Care (Feb. 16,1991, GAO/HRD9l41).

Health Insurance Coverage: A Profde of the Uninsured in Selected States (Feb.8,1991,~~om~DolSlFs).

Home Visiting: A Promising Early Intervention Service Delivery Strategy (Oct. 2, 1999, G~O/r-~Rrs~i-o2). Report on same topic (July 11, 1990, GAO/HRDfMMB).

Budget Issues: Effects of the Fiscal Year 1990 Sequester on the Department of Health and Human Services (Aug. 9,1999, GAOIHRD-WISBFS).

Rural Hospitals: Factors That Affect Risk of Closure (June 19,1996, GAO/HRD-90-134).

Rural Hospitals: Federal Leadership and Targeted Programs Needed (June l&1990, ~~0mRD9o-67).

Health Insurance: A Profile of the Uninsured in Michigan and the U.S. (May31,1990, GAO/HRDB@97).

Health Insurance: Cost Increases Lead to Coverage Limitations and Cost Shifting(May22,1990,GAO/HRD-90-68).

Pue12 GMJIEED-92-84HealthIteporta

Medicare and Medicaid

Medicare: Over $1 Billion Should Be Recovered From Primary Health Insurers(Feb.21,1992, GAO/HRD-Q~~~).

Medicare: Rationale for Higher Payment for Hospital-Based Home Health Agencies (Jan. 31,1992, GAO/HRD-0~).

Medicare: Third Status Report on Medicare Insured Group Demonstration Projects(Jan.29,1992, GAOMRJNIZ-B).

Veterans’ Benefits: Savings from Reducing VA Pensions to Medicaid- Supported Nursing Home Residents (Dec. 27,1991, GAOMELO~%).

Medicare: HCFA Needs to Take Stronger Actions Against nhfos Violating Federal Standards (Nov. 15,1991, GAO/~-HRDOZ~~). Report on same topic (Nov.12, 1~1,GAOMRDSZll).

Medicare: Effect of Durable Medical Equipment Fee Schedules on Six Suppliers’ Profits (Nov. 6,1991, GAO~RD-9222).

Significant Reductions in Corporate Retiree He&h Liabilities Projected If Medicare Eligibility Age Lowered to 66 (Nov. 5,199l; GAOFI-HRD-B%~).

Medicare: MilIions of DoIIars in Mistaken Payments Not Recovered (Oct. 21, 1991, GAOkIRD-9226).

Medicare: Improper Handling of Beneficiary Complaints of Provider Fraud and Abuse (Oct. 2, 1991, GAOIHRIIOZI). Testimony on same topic (Oct. 2, 1991, GAm-HRD-92-2).

Medicaid: Changes in Drug Prices Paid by VA and DOD Since Enactznent of Rebate Provisions (Sept. 18, 1991, GAO/HRITBI-13~).

Health Care: Actions to Terminate Problem Hospitals From Medicare Are Inadequate (Sept. 5,1991, GAO/HRDQLM).

Medicare: Information Needed to Assess Payments to Providers (Aug. 8, 1991, GAOMRD-91-113).

Medicaid Expansions: Coverage Improves but State Fiscal Problems Jeopardize Continued Progress (June 25,1991, GAOMRD-91-78).

PwelI GAO/HBD-92-6-i Health Bqmta

Medicare md Medicaid

Substance Abuse Treatment: Medicaid Allows Some Services but Genera& Limits Coveme (June 13,1991, oAomr%ai-92).

I .

Medicare: Further Changes Needed to Reduce Program Costs (June 13, 1991, kAOfr-IiRB9134). Report on same topic (May 15,1991, GAcUHnn-9l87).

Medicare: Payments for Clinical Laboratory Test Services Are Too High (June 10, 1991, GAOIHRD~M~).

Medicare: Flawed Data Add Millions to Teaching Hospital Payments (June 4, 1991, GAOmEG9l-31).

Medicaid: Alternatives for Improving the Distribution of Funds (May 20, 1391, GAWnzD-81-66Fs). Testimony on same topic (Dec. 7,1990, GAO/THRD-gl-6).

Medicare: Variations in Payments to Anesthesiologists Linked to Anesthesia Time (Apr. 30.1991, GAOmRD91-43). . -

Medicare: HCFA Should Improve Internal Controls Over Part B Advance Payments (Apr. 17,1991, GAO/HRD91-81).

Medicaid: HCFA Needs Authoritv to Enforce Third-Partv Reauirements on States (Apr. 11, 1991, GAO~RD-91-60).

Medicare: Millions in Disabled Beneficiary Expenditures Shifted to Employers (Apr. 10,1%X, GAomm91-24).

Medicare Claims Processing: HCFA Can Reduce the Disruptions Caused by Replacing Contractors (Am. 4.1991. GAOmRD91-44).

Medicare: Need for Consistent National Payment Policy for Special Anesthesia Services (Mar. 13, 1331, GAO/HRD91-23).

Medicare: PRO Review Does Not Assure Quality of Care Provided by Risk HMOS (Mar. 13,1!391, GAom-HRrm-12). Report on same topic (Mar. 12,1991, GAOIHRD9148).

Medicare: Mihions in Potent&I Recoveries Not Being Sought By Contractors(Feb. 26,1991,GAO/r-HRD-918).

Page 14 GAmmD-92-84 Bdtb Reports

Medicaremdbdierld

Prenatal Care: Early Success in Enrolling Women Made Eligible by Medicaid Expansions (Feb. 11, 1991, GAwl%i&f&Io).

Medicare: Millions in Potential Recoveries Not B&g Sought by Maryland Contractor (Jan. 26.1091. GAcmRD9l42). .

Medicaid: Legislation Needed to Improve Collections from Private Insurers (Nov.30,1~,GAOmRB91-26).

Medicaid: Millions of Dollars Not Recovered From Blue Cross/Blue Shield (Nov. 30, 1990, GAO/HRB91-12).

Medicare: Comparison of Two Methods of Computing Home Health Care COStZ3~tS(!kpt. 28,1~,GAO/HRD9@167).

bong-Term Care Insurance: Proposals fo Link Private Insurance and Medicaid Need Close Scrutiny (Sept. 10,1990, GAO/HRIMMH).

Nursing Homes: Admission Problems for Medicaid Recipients and Attempts to Solve Them (Sept. 6,1990, GAOIHRD-9~16)).

Medicare: Options to Provide Home Dialysis Aides (Aug. 31,1990, GAO/HRD9O-163).

Medicaid: Oversight of Health Maintenance Organizations in Chicago Area (Aug.27,19~,GAOmRMO-81).

ADP Systems: HCFA'S Faihare to Follow Guidelines Makes System Effectiveness Uncertain (July 26,1990, GAOLMTECXWM).

Medicare: Comparative Analysis of Payments for Selected Hospital Services (July 6, 1990, GAO/HRDQO-108).

HCFA Needs Better Assurance That Hospitals Meet Medicare Conditions of Participation (June 241990, GA~,T-HRD-91~4).

Medicare: HCFA Can Reduce Paperwork Burden for Physicians and Their Patients (June 20,199O. GAOIHRD-90-~+6). .

Medicare: Second Status Report on Medicare Insured Group Demonstration Projects (June 6,1990, GAOIHRD-Q&~~~).

Page16 GAo/ERD-92-94 Eealth Eeporta

Medicare and MedicaId

Medicare: Employer Insurance Primaty Payer for 11 Percent of Disabled ~nefiCiaries(~lo,l~,GAo/HR~79).

Medicaid: Sources of Information on Mental Health Services (May 7,1990, GAO/HRtiDb100).

Medicare: Alternativei for Computing Payments for Hospital Outpatient Surgery (Apr. 3,1990, GAOIHRLWMQ

Medicare Catastrophic: Roll Back of Premiums on Schedule (Mar. 16, 1990, GAOAMTEC-M).

Medicare and Medicaid: More Information Exchange Could Improve Detection of Substandard Care (Mar. 7,1990, GAO/HRD-MMJ).

Medicare Part A Reimbursements: Processing of Appeals Is Slow (Feb. 9, 1~,GAo/HRD9&23BR).

Medicare: Withdrawing Eye@ass Coverage F&commended Following Cataract Surgery (Feb. 8,1990, GAOJHRLMKU).

P-e16 GAIXBBD-92-94 Health Eepmt~

Public Health and Education

Drug Education: Rural Programs Have Many Components and Most Rely Heavily on Federal Funds (Jan. 31,1992, GAOlHRD9234).

tins-Prevention Programs: High-Risk Groups Still Prove Hard to Reach (June 14, 1991, GAOmRJMJl-62).

Mental Health Grants: Funding Not Distributed in Accordance With State Needs(May16,1991, GAofr-HRIT9132).

Medical Malpractice: Data on Claims Needed to Evaluate Health Centers’ hw.iranceAhematives(May2,1~1, GAOIHRD-91-98).

Community Health Centers: Hospitals Can Become Centers Under Certain Conditions (Mar. 22,1!%1, GAOMRD9b'Im).

Accidental Shootings: Many Deaths and Injuries Caused by Firearms Could Be Prevented (Mar. 19,1991, GAOIPEMD-gl-9).

Indian Health Service: Funding Based on Historical Patterns, Not Need (Feb. 21,1991, GAomRD91-6).

Mental Health Plans: Many States May Not Meet Deadlines for Plan Implementation(Sept. 18, 199O,GAOmRD-W142).

National Health Service Corps: Program Unable to Meet Need for Physicians in Underserved Areas (Aug. 10,1990, GAO~RLMO-128).

Health Care: Public Health Service Funding of Community Health Centers in New York City (Aug. 17,1%0, GAO~RD-9&121).

Minority Health: Information on Activities of HHS'S Office of Minority Health (June 6,1%+0, ~~0i~~~90-140~s).

AIDS Education: Programs for Out-of-School Youth Slowly Evolving (May 1, 19%),GAO/HRD-SO-Ill).

AIDS Education: Public School Programs Require More Student Information and Teacher Training (May 1,1990, GAOIHRD-90-103).

Black Lung Program: Further Improvements Can Be Made in Claims Adjudication (Mar. 21,1990, GAOIHRDW76).

Page17 GMMERD-92434HerlthReporta

Health Quality and Practice Standards

Breast Cancer, 1971-91: Prevention, Treatment, and Research (Dec. 11, 1991, GAOIPEMb92-12). Testimony on same topic (Dec. 11,1991, GAOIT-PEMD-92-4).

VA Health Care: Compliance With Joint Commission Accreditation Requirements Is Improving (Dec. 13, 1991, GAo/HRD92-19).

Screening Mammography: Quality Standards Are Needed in a Developing Market (Oct. 24, 1991, GAo&r-rRD923).

Health Care: Actions to Terminate Problem Hospitals From Medicare Are bCkqU&(!kpt. 5,1991,GAO/HRD-91-64).

Health Care: Hospitals With Quality-of-Care Problems Need Closer Monitoring (May 9,1991, GAO/HRD9l-40).

Health Care: Limited State Efforts to Assure Quality of Care Outside Hospitals (Apr. 29, 1991, GAO/r-HRD91-20).

Medicare: PRO Review Does Not Assure Quality of Care Provided by Risk HMOS (Mar. 13, 1991, GAO/r-HRBSI-12). Report on same topic (Mar. 12,1991, GAO/'HRD9148).

Practice Guidelines: The Experience of MedicaI Specialty Societies (Feb. 21, 1991, GAO/PEMD-91-11).

Medical ADP Systems: Automated Medical Records Hold Promise to Improve Patient Care (Jan. 22,1991, GAO/IMTEG9id).

Information Systems: National Health Practitioner Data Bank Has Not Been Well Managed (Aug. 241990, GAO/IMTECXJO&

Medicare Appeals Process: Part B Changes Appear to Be Fulfiig Their Purpose(Jmyl6, 1990, GAO/IiRDW67).

HCFA Needs Better Assurance That Hospitals Meet Medicare Conditions of kutiCipatiOn(~Une 21, l%@,GAOtT-HRLW44).

Health Care: Criteria Used to Evaluate Hospital Accreditation Process Need Reevaluation (June 11,1990, GAO~HRB~~B~).

Page18 GAo/BpD-92-M Health Reports

Medical Licensjng by Endorsementi Requirements Differ for Graduates of Foreign and U.S. Medical Schools (May 17,1990, GAOiEIRD9M20).

Infection Control: Milky Programs Are Comparable to VA and Nonfederal F’ro@uns but Can Be Enhanced (Apr. 27,1990, GMk'HRIW74).

Medicare and Medicsid: More Inform&ion Exchange Could Improve b?t&iOnOf&lbStandardC~(Mar. 7,1!%0, GAQ'RRDW29).

Quality Assurance: A Comprehensive National Strategy for Health Care Is Needed(Feb.21,1990, GA~DW~~BR).

F

Long-Tern-i Care and Aging

Long-Tern Care Insurance: Risks to Consumers Should Be Reduced (Dec. 26,1991, GAO~RD~M~). Testimony on same topic (Apr. l&1991, GAOIFHRD-91-14).

Aging Issues: Related GAO Reports and Activities in Fiscal Year 1991 (Dec.17,1%& GAOIHRD9ZS7).

Long-Term Care Insurance: Consumers Lack Protection in a Developing Market (Ott, 24,1991, GAommm-6).

Administration on Aging: More Federal Action Needed to Promote Service Coordination for the Elderly (Sept. B,l!%l, GAOIHRD-9146).

Long-Term Care: Projected Needs of the Aging Baby Boom Generation (June 14,1991, GAcmm-91%).

Elder Abuse: Effectiveness of Reporting Laws and Other Factors (Apr. 24, 1991, GAO/HRD91-74).

Aging Issues: Related GAO Reports and Activities in Fiscal Year 1990 (Dec. 14, 1990, GAOmRB9147).

Long-Term Care Insurance: Proposals to Link Private Insurance and Medicaid Need Close Scruthy (Sept. IO, 1990, GAO/HRIMU&Q).

Respite Care: An Overview of Federal, Selected State, and Private fio@ams(%pt. 6,1990, GAO/HRD9&126).

Nursing Homes: Admission Problems for Medicaid Recipients and Attempts to Solve Them (Sept. 6,1Q90, GAONRIMW~S).

VA Health Care: Improvements Needed in Nursing Home Planning (June12,1990, GAOIHRMC-9t3).

Page20 GAMiRD-92-84 Health Report0

Substance Abuse and Drug Treatment

Drug Education: Rural Programs Have Many Components and Most Rely Heavily on Federal Funds (Jan. 31,1992, GAOIHRD9234).

Adolescent Drug Use Prevention: Common Features of Promising (.hnn’~uni~ ~o@ams (Jan. 16, 1992, GAO/PEMD92-2).

Drug Abuse Research: Federal Funding and Future Needs (Jan. 14,1992, GAOIPEMD-92-6). Testimony on same topic (Sept. 25, 1991, GAOIPEMD-T-91-14).

ADMS Block Grant: Drug Treatment Services Could Be Improved by New Accountability Program (Oct. 17, 1991, GAomRD-92-27). Testimony on same topic @Ct. 17, 1991, GAO/T-HRD-924).

Drug Treatment: State Prisons Move to Enhance Treatment (Sept. 20,1991, GAO/HRD-91-128).

Drug Treatment: Despite New Strategy, Few Federal Inmates Receive Treatment (Sept. 16, 1991, GAO/HRD91-116).

Drug Abuse Prevention: Federal Efforts to Identify Exemplary Programs Need Stronger Design (Aug. 22,1991, GAOmhiD-w-16).

Substance Abuse Funding: High Urban Weight Not Justified by Urban-Rural Differences in Need (June 25, 1991, GAOII’-HRD-9138).

Substance Abuse Treatment Medicaid AUows Some Services but Genera& Limits Coverage (June 13,1991, GAomRD91-92).

Promising Community Drug Abuse Prevention Programs (May 17,1991, GAO/r-PEMIbSl-7).

ADMS Block Grant: Women’s Set-Aside Does Not Assure Drug Treatment for Pregnant Women (May 6,1991, GAo/HRD-9180). Testimony on same topic (June 20, 1991, GAO/T-HRD9137).

Alcoholism Screening Procedures at VA Medical Centers (Apr. 18,1991, GAofr-HRD-91-16). Report on same topic (Mar. 27, 1991, GAOIHRD-91-71).

Drug Abuse: The Crack Cocaine Epidemic: Health Consequences and Treatment (Jan. 30, 1991, GAOIHRDSl-WS).

Page 21 GAO/HED-92434 Health Beports

Subbtauce Abuse aad Dmg Treatmeat

Teenage Drug Use: Uncertain I&&ages With Either Pregnancy or School Dropout (Jan. l&1991, GAOIPEMD913).

Drug Treatment: Targew Federal Aid Using Urban Population to Reflect State Differences in Drug Use (Nov. 27,1990, GAOIHRD-91-17).

Drug Abuse: Research on Treatment May Not Address Current Needs (tit. 10, l%%$GAOfF-HRD91-3).

Rural Drug Abuse: Prevalence, Relation to Crime, and Programs (Sept. 14, ~!i@&GAO/l'EMLNJ@24).

Drug Abuse: Research on Treatment May Not Address Current Needs @pt. 12, 1990, GAO/HRJNJ&114).

Drug-Exposed Infants: A Generation at Risk (June 28,1990, GAOIHRLNW~).

Drug Treatment: Some Clinics Not Meeting Goai of Prompt Treatment for Intravenous Drug Users (Apr. 30,1990, GAO/HRINXLEOBR).

Drug Testing: Action by Certain Agencies When Employees Test Positive for Illegal Drugs (Apr. 6,1990, GAO/GGB~IIBFS).

Methadone Maintenance: Some Treatment Programs Are Not Effective; Greater Federal Oversight Needed (Mar. 22,1990, GA~~HRNW-UI~).

Page22 GMMfRD-92-U Health Beports

Military and Veterans Health Care

VA Health Care: VA Plans Will Delay Establishment of Hawaii Medical Center(Feb. 26,1%2,GAOMRB92-41)

Operation Desert Storm: Full Army Medical Capability Not Achieved (Feb. 5, 1992, GAcvr-NSlAD-924%).

VA Health Care for Women: Despite Progress, Improvements Needed (Jan.23,1992, GAOIHRD-9223)

VA Health Care: Modernizing VA'S Mail-Service Pharmacies Should Save Miiiions of Dollars (Jan. 22,1992, GAOIHRD-9230).

Defense Health Care: Transfers of Military Personnel With Disabled Children [Jan. 9, 1992, GAOmRB9%16).

Defense Health Care: Efforts to Address Health Effects of the Kuwait Oil well Fires (Jan. 9,l992, GAOmRB92-60).

VA Health Care: Compliance With Joint Commission Accreditation Requirements Is hnproving (Dec. 13,1991, GAOIHRD-92-19).

DOD Medical Inventory: Reductions Can Be Made Through the Use of Commercial Practices (Dec. 5,1991, GAo~s~92-68). Testimony on same topic (Dec.& 1991, GAO/r-NSIADg2-6).

Defense Health Care: CHAMPUS Mental Health Benefits Greater Than Those Under Other Health Plans (Nov. 7, 1991, GAOIHRD-92-20).

Defense Health Care: Implementing Coordinated Car-A Status Report (Oct. 3, 19'91,GAOklRD-9210).

Health Care for Hawaii Veterans (Aug. 16,l99l, GAofr-HRD-9145).

Medicaid: Changes in Drug Prices Paid by VA and DUD Since Enactment of Rebate Provisions (Sept. 18,1991, GAoMRIx%lx#).

VA Health Care: Telephone Service Should Be More Accessible to Patients (July31, 1991, GAO&D-91-MI).

Veterans’ Benefits: VA Needs to Verify Medical Expenses Claimed by Pension BeneEciaries (July 29,1991, GAomm-91-94).

Pmge23 GAO/HRD-92-34IieaithReporta

Controls Over Addictive Drugs in VA Pharmacies (June 19,1991, GAOfMRD-91-3s).

VA Health Care: Inadequate Controls Over Addictive Drugs (June 6,1991, GAOiHRD-91-101).

Defense Health Care: Health Promotion in DOD and the Challenges Ahead (June 4, 1991, GAOiHRD9b76).

VA Health Care: Delays in Awarding Major Construction Contracts (May 30, lt#l,GAO/HRD-91-84).

DOD’S Management of Beneficiaries’ Mental Health Care (Apr. 24,1991, GAO~T-HRD~L18). Testimonyonsame tOpiC (May 16, 1991,GAofl-HRB9130).

Alcoholism Screening Procedures at VA Medical Centers (Apr. 18,1991, GAO/r-H~tbBl-16). Report on same topic (Mar. 27, 1991, GAO/HRD~~-71).

The Military Health Services System-Prospects for the Future (Mar. 14, 1991, GAO/THRD-91-11).

Defense Health Care: Procurement of an Interactive Videodisc Program for AIDS Education (Feb. 13,1991, ~Aok1~~9i-tx1).

VA Health Care: Actions in Response to VA'S 1989 Mortality Study (Nov. 27, Ifi)!%), GAO/'HRD91-26).

Defense Health Care: Potential for Savings by Treating CHAMPUS Patients in Military Hospitals (Sept. 7, 1990, GAO/HRP~WI).

Military Health Care: Savings to CHAMPUS From Using a Prospective Payment System (July 13,1990, GAOIHRMO-MS-S).

VA Health Care Cost Recoveries (June 20,1990, GAO/~-HRDWO).

VA Health Care: Improvements Needed in Nursing Home Planning (June 12, 1990, GAO~RD~U~S).

Infection Control: Military Programs Are Comparable to VA and Nonfederal Programs but Can Be Enhanced (Apr. 27,1990, GAOIHRPW74).

Pkkge24 GAMERD-9%84He&ltRepmta

Military and Vetcram Health Cue

VA Health Care: Better Procedures Needed to Maximize Collections From Health Insurers (Apr. 6,1990, GA-D-9~).

VA Health Care: Delays in Awarding Major Construction Contracts (Apr. 5, 1i%&GAOiHRD9@91).

Access to Medical Care at Overseas Military Hospitals (Mar. 29,1990, GAOfPHRtM@20).

VA Health Care: Medical Centers Need to Improve Collection of Veterans’ Copayments (Mar. 28,1990, G~oMRn9@77).

Defense Health Care: Military Physicians’ Views on Military Medicine (Mar.22,1~,GAO/HRD-Wl).

DUD Health Care: Funding Shortfalls in CHAMPUS, Fiscal Years 198591 (Mar. 19,1~,GAO/HRlNM9BR).

Medical ADP Systems: Defense Faces a Difficult Task (Mar. 16,1990, GAO/lMTEC-M2).

Potential Expansion of the CHAMPUS Reform Initiatives (Mar. 15,1990, GAO/r-HRD-9M7).

Defense Health Care: Effects of AIDS in the Military (Feb. 26,1990, GAO/HRD-W39).

VA Health Care: Veterans’ Concerns About Services at Wilmington, Delaware, Center (Feb. 8, 1990, GAOIHRMCMXBR).

P8ge 21 --92-84 Health Report4l

Employee and Retiree Health Benefits

Hired Farmworkers: Health and Well-Being at Risk (Feb. 14,1992, GAoJHRD-92-46).

States Need More Department of Labor Help to Regulate Multiple Employer Welfare Arrangements and Correct Problems (Sept. 17,19!31, GAOfF-HRD-91-47).

Employee Benefits: Effect of Bankruptcy on Retiree Health Benefits (Aug.30, 1991, GAO/HRDSl-116).

Veterans’ Benefits: VA Needs to Verify Medical Expenses Claimed by Pension Beneficiaries (Julv 29.1991. GAO~RD-9i-941.

Farmworkers Face Gaps in Protection and Barriers to Benefits (July 17, 1991, GAOMRD-9140).

Retiree Health: Company-Sponsored Plans Facing Increased Costs and Liabilities (May 6, 1991, GAOfr-HRDQl-26).

Employee Benefits: Improvements Needed in Enforcing Health Insurance Continuation Requirements (Dec. 18,1990, GAO~RD-9137).

Disability Programs: Use of Competitive Contracts for Consultative Medical Exams Can Save Millions (Aug. 17,1990, GAOIHRD-9&141).

Employee Benefits: Trends in Retiree Health Coverage (July 27,X190, GAO/THRDWil).

Social Security: Employment and Health Status of Social Security Denied Applicants(July17, ~~,GAO~~-HRNO-@.

Employee Benefits: Extent of Multiemployer Plan Retiree Health Coverage (July 17, 1990, GAO/HRD-90-132).

Veterans’ Compensation: Medical Reports Adequate for Initial Disability Ratings but Need to Be More Timely (May 30,1990, GAO/WRD-~O-~~~).

Employee Benefits: Extent of Companies’ Retiree Health Coverage (Mar.28,1990, GAO/HRDW92).

Page26 GADICIBD-92-94 Be&h Re.garta

Other Health Issues

Food and Drug Administration

FDA Regulations: Sustained Management Attention Needed to Improve Timelyksuance(Feb.21, 1992, ~~o/HRD9236).

Freedom of Information: FDA'S Program and Regulations Need Ixmxovement (Oct. 11, 199 1, GAOIHRD-~~-~).

Food Tampering: Legal Authority Adequate to Deal with Threats (Oct. 31, 1990, GAO/HRD-91-20).

Food Tampering: FDA'S Actions on Chilean F’ruit Based on Sound Evidence (Sept. 6,1990, GAOIHRDWUX).

Food and Drug Administration: GAO'S Perspective (July 11,1990, GAOIT-HRLNN-47).

Medical Devices: Underreporting of Serious Problems With a Home Apnea Monitor ~a!,31,1990,GAO/PEMD-gO-17). . -

Food Irradiation: Federal Requirements and Monitoring (May 3,1990, GAO/HRD-W118).

FDA Drug Review: Postapproval Risks 19761985 (Apr. 26,1990, GACYPEMD-W15).

Cosmetic Retiation: Information on Volunm Actions Anreed to by FDA

and the Industry (Mar, 13,1990, GAO/HRDW@.

Medical Malpractice Medical Malpractice: Alternatives to Litigation (Jan. 10,1992, GAO/HRD92-28).

Medical Malpractice: Data on Claims Needed to Evaluate Health Centers’ kIsuranceA]tematives (May 2,1991,GAonrRD-91-98).

Medical Malpractice: Few Claims Resolved Through Michigan’s Voluntary Arbitration Program (Dec. 27,1990, GAOIHRD-9138).

Medical Malpractice: A Continuing Problem With Far-Reaching Implications (Apr. 26, 1990, GAOI~-~~~90-24).

Page27 GA#HED-9244HerlthEeports

1 Prescription Drugs Rebate Provisions (Sept. 18,1991, GAQ~D~~-139).

Prescription Drugs: Selected Dire&to-Consumer Advertising Studies Have Methodological F’bvs ljuly 22.1991, GAOPEMD-91-20).

Prescription Drugs: Little Is Known About the Effects of Dhz&t&onsumer Advertising (July 9,1991, GAOIPEMDQL19).

Off-Label Drugs: Initial Results of a National Survey (Feb. 25,1991, GAOIPEMD-91-12BR).

Miscellaneous Unknown but Assessments Are Under Way (Jan. 16,1992, GAONED924OBR).

Occupational Safety & Health: OSHA Action Needed to Improve Compliance With Hazard Communication Standard (Nov. 26,1991, GAOMRD-~8).

Medical Residents: Options Exist to Make Student Loan Payments Manageable (Nov. 26, 1991, GAo/HRD-92-21).

Reproductive and Developmental Toxicants: Regulatory Actions Provide Uncertain Protection (Oct. 2,1991, GAO/PEMD923). Testimony on same topic (Oct. 2, 1991, GAO/r-PEMD-92-1).

Health Care: Antitrust Issues Relating to Physicians and Third-Party Payers (July 10, 1991, ~~om~~el-l2o).

Health Services: Available Research Shows That Capacity Is Only Weakly Related to Volume (Jan, 81,1991, GAOIPEMD-91-7).

Army Biomedical Research: Concerns About Performance of Brain-Wound Research (Dec. 12,1990, GAO/HRD-9130).

Disability Programs Use of Competitive Contracts for Consultative Medical Exams Can Save Millions (Aug. 17. x996.

National Institutes of Health Problems in Implementing Policy on Women in Study Populations (June 18,1996, GAO/~-HRDQKS).

Drug T&ing: Action by Certain Agencies When Employees Test Positive for Illegal Drugs (Apr. 6,1990, GAON~GD-W)-~~FS).

Black Lung Program: Further Improvements Can Be Made in Claims Adjudication (Mar. 21,1990, GAmm76).

Page as GAOIEED-92-81 Health l&ports

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